Humbled at the bedside

Howard Sachs

Dear Team SARS-CoV-2,

This note will require a word of background. The offices of Graduate Medical Education (GME) and the Chief Medical Officer (CMO) suggested that senior faculty/mentors reach out to our front-line workers/heroes and thank them for their service while inquiring about their emotional well-being. Logistically, I think I was supposed to text you individually, but I don’t really text, and I thought we needed a sense of community rather than isolation.

Further, and to be truthful, I thought the idea was a bit silly and initially rolled my eyes. That all changed over the last 4 days…read on if you have a moment…

I volunteered to be part of the surge response team (‘guest faculty’). My first tour was on the non-COVID floor (6W) getting re-acquainted with inpatient flow and Epic. My original intent, having turned 60 and winding down in my career, would be to support 6W while the young Turks dealt with the inpatient surge. But things never go as planned and during this past week I accepted deployment to the DCU and here’s where the story takes a turn.

Having completed the four-day assignment on a COVID ward, I am shocked by how the experience has affected me. In fact, I’m still trying to sort out the emotional whirlwind AND this became the trigger to check in with you experts. I was so moved by the genuine and deep abiding gratitude of our patients. Even as they crashed before my eyes, all interactions ended with, ‘thank you doctor. Thank you so much for what you are doing. Please be safe and take care of yourself.’ Patients who were heading to the units, where a mechanical ventilator waited, took the time to acknowledge our efforts. When I discussed this with my HM colleague (Dr Hajjiri), he commented that patients in the hospital typically expect to get better. They take it for granted BUT the COVID patients only know what they hear on the news…the real possibility of death.

During the deployment, I had the opportunity to call families to inform them their parent is ready for discharge; that their parent won the battle…that death had not taken them. Then the families became effusive with praise knowing their parent might have passed but instead is coming home.

Moreover, our colleagues, sitting at our elbows (and not social distancing), have risen to the occasion, joining as one, in fighting a common enemy…the unseen and brilliant enemy. Whereas the collegiality is not surprising, it has rarely been so tested.

So today is a recovery day. I am overwhelmed trying to process the experience. Yet, you do this day in and day out. You are truly the front line; you are in the trenches. You are looking at ground glass opacities and O2 saturations and attaching those values to the faces of your patients. And you go to the bedside carrying your greatest medical asset: hope (and supplemental oxygen). And you yourselves are hoping against all odds that your patients don’t crash, shackled by the precious few preemptive options. And in the process, you are discovering the bravery of our patients; how they are the heroes; how they are determined to ‘beat this thing.’ And throughout this process, you are knee deep in the fray, all the while caring deeply for these strangers, with a strange disease and alienated from their loved ones. They are alone but for you, your professional expertise and the extent to which you care.

And so when GME/CMO said to text ten residents, I thought it was silly…but now I don’t. You have officially become my COVID community because you understand. Only you, in the trenches, can appreciate when a Vietnamese patient, who doesn’t speak English, finds a way to thank you again and again just before his ICU transfer.

So whereas I am so supposed to offer mentoring, I think it is quite the opposite; I would invite you to mentor me (or one another). If you have a story to share, please do. If you wish to ‘journal’, please do so. If I am nuts, feel free to say so. I am usually pretty indifferent and quite a bit self-centered…yet, four days of COVID pneumonia and Epic ‘dot’ phrases and bedside interpreters and grateful patient-heroes have all moved me in way that was unexpected and not previously experienced in my 30 year career. And although I might be wrong, I’m guessing if I am impacted this way, after four 12-hour shifts, you must be either completely numb or experiencing similar turmoil?

So I will certainly offer a word of praise for your efforts, but a single phrase could not possibly reflect the depth of your accomplishments while literally putting your lives on the line. I think Lincoln said it succinctly 164 years ago: We cannot dedicate, we cannot consecrate, we cannot hallow this ground…and so it goes. A brief word of praise will not and cannot honor your work but honored it must be.

I apologize for the length of this ‘text.’ Please feel free to share your thoughts and/or concerns with our newly convened COVID community. I would be honored if, for any reason, you chose to call instead. Whereas I’ve spoken to friends, family and colleagues, it is hard for those outside the fray to appreciate the intensity of the work and the look of despair in the faces of our patients. I look forward to hearing/learning from my great professional colleagues.

With the greatest of respect,

Howard Sachs, MD

Howard Sachs, MD is an associate professor of medicine in the Division of Primary Care in the Department of Medicine.  He has worn numerous hats at UMass Medical School: current course director for the “Patients” course for second year medical students, former director of ambulatory medical service, former physician unit chief for the adult primary care clinic, and former associate director of the Internal Medicine Residency Program.  He has been honored multiple times for excellence in teaching both medical students and internal medicine residents.

Dr. Sachs originally wrote this note to ten residents, and then shared a version of the piece on Group Talk. Reflecting with the editor of The Interstitium, he wrote, “The experience on the COVID unit wasn’t like anything I was expecting. I was stationed at a field hospital which felt like a throwback to the open hospital wards in the 60s. Yet the disease, staff and most of all, patients, created an environment or community like nothing I’ve previously experienced. I have signed up to return to the unit in a couple of weeks. Most of the patients don’t speak English and are in a strange and lonely place. The degree to which we offered caring and compassion was escalated to an unprecedented degree especially since we don’t have definitive interventions for these folks. I was able to offer education, hope and oxygen.”